Chiropractic insurance billing in Indiana.

Medicare’s chiropractic rules are federal — the same in every state. Medicare Part B covers ONLY manual manipulation of the spine to correct a subluxation (CPT 98940–98942), and ONLY when the care is active or corrective — which you signal with the AT modifier. Maintenance care, exams, X-rays, and any therapies performed by a chiropractor are not covered, so a properly executed ABN is essential before non-covered services. The full federal rules are in our chiropractic Medicare billing guide.

Part B claims in Indiana are processed by WPS Government Health Administrators (J8) — its Local Coverage Determination and documentation expectations (and its audits of the AT modifier and medical necessity) are the ones your Indiana claims are measured against.

A Indiana chiropractic or multi-specialty practice spends most of its commercial billing day with: Anthem Blue Cross Blue Shield (Elevance Health); UnitedHealthcare; Centene (Ambetter / managed Medicaid); CareSource; Aetna; Cigna.

Each has its own claim portal, fee schedule, and chiropractic medical-policy quirks.

The dominant DELEGATED musculoskeletal/chiropractic network and utilization managers operating in Indiana are American Specialty Health (ASH), Optum (UnitedHealth Group), and Carelon Medical Benefits Management (formerly AIM Specialty Health, the Elevance/Anthem clinical-review arm).

• AMERICAN SPECIALTY HEALTH (ASH) — ASH is active in Indiana (it has an operations presence in Carmel, IN) and administers chiropractic (and often acupuncture, and in many markets physical/occupational therapy) for CIGNA: when a Cigna plan delegates to ASH, network contracting, the treatment-plan/medical-necessity review, and CLAIMS route to ASH (ashlink.com), NOT to Cigna directly. ASH also has long-standing relationships with Aetna and various Blue plans. A Cigna chiropractic claim or auth sent to Cigna instead of ASH is a common denial cause — check the member card.
• CARELON / AIM (Anthem Blue Cross and Blue Shield of Indiana / Elevance) — Anthem uses Carelon Medical Benefits Management (ex-AIM Specialty Health) for prior authorization / clinical-appropriateness review of outpatient PT/OT/ST and chiropractic on many Anthem products in Indiana (effective for Indiana Medicaid rehab services since 4/1/2019, and on commercial/MA lines per the plan); the CLAIM still goes to Anthem, but the AUTH/clinical review goes to Carelon/AIM (provider portal / 1-800-714-0040).
• OPTUM / Optum Physical Health (UnitedHealth Group) — manages chiropractic and outpatient therapy for UnitedHealthcare; UHC requires prior authorization for chiropractic/PT/OT/ST for Medicare Advantage members (national rollout effective 9/1/2024; initial evaluation exempt, the ongoing treatment plan/visit count needs review delegated to Optum via the UHC Provider Portal/Optum systems). Always verify on the member’s card/portal whether chiropractic is carved out to ASH (Cigna) or whether auth runs through Carelon/AIM (Anthem) or Optum (UHC), because that determines where authorizations and claims go; delegation arrangements change by plan/product/year, so re-confirm.

What trips up chiropractic billing in Indiana:

• INDIANA CHIROPRACTIC EQUAL-REIMBURSEMENT STATUTE — IC 27-8-6-1 provides that if an accident-and-sickness policy reimburses a service within the lawful scope of a duly licensed Indiana chiropractor, the insured is entitled to reimbursement on an EQUAL basis whether the service is performed by a physician or by a licensed chiropractor (a non-discrimination mandate). It does NOT force coverage of a service the plan doesn’t otherwise cover, set rates, or override Medicare/Medicaid program rules. Note also IC 25-1-9-6.5, which restricts a chiropractor’s routine waiver of deductibles/copays.
• INDIANA MEDICAID CHIROPRACTIC IS TIGHTLY CAPPED — the IHCP covers chiropractic but limits reimbursement to a total of 50 UNITS per member per calendar year (any combination of office visits, spinal manipulation, and physical-medicine services), and within that, OFFICE VISITS are limited to FIVE
• per year; additional services need prior authorization based on medical necessity. Reimbursement is tied to approved condition-related ICD diagnosis codes; DME and EMG testing by chiropractors are NOT reimbursed. CRITICAL plan distinction: HIP Basic (the lower Healthy Indiana Plan tier) does NOT cover chiropractic (nor dental/vision), while HIP Plus and other Medicaid categories do — so a Medicaid card alone does not guarantee chiropractic is payable; check the specific aid category/plan.
• COMMERCIAL VISIT CAPS / MEDICAL-NECESSITY — the dominant Indiana commercial payer is Anthem/Elevance (~56% commercial share, far ahead of UnitedHealthcare), followed by UHC, Aetna, and Cigna; these plans generally cover spinal manipulation (98940-98942) only when medically necessary for an active neuromusculoskeletal condition under a documented WRITTEN treatment plan with periodic re-evaluation. ‘Maintenance’/supportive care is typically not reimbursable; many plans impose ANNUAL VISIT CAPS (commonly ~20-30 chiropractic/therapy visits per year, plan-dependent) and per-date unit/code caps. Extra-spinal manipulation (98943) and therapy modalities/exercise codes (97xxx) often need correct modifiers (e.g., -59/-XS for distinct services, GP under a PT plan of care) and may be denied as bundled/not separately payable.
• PRIOR-AUTH / DELEGATION QUIRKS — Anthem (IN) routes chiropractic/therapy clinical review through Carelon/AIM; Cigna chiropractic is frequently delegated to ASH (send auth/claims to ASH, not Cigna); UHC Medicare Advantage now requires prior auth (via Optum) for the chiropractic treatment plan after the exempt initial eval — sending these to the wrong entity is a leading denial cause.
• MEDICARE — spinal CMT (98940-98942) must carry the AT modifier for active/corrective treatment; routine ‘maintenance’ manipulation is non-covered (bill with GA/GZ as appropriate plus an ABN); X-ray is no longer required to demonstrate subluxation but documentation must support it; CMT is the only chiropractor service Medicare pays (exams, X-rays, and therapy ordered/performed by a chiropractor are statutorily non-covered for Medicare).
• WORKERS’ COMP — treatment is employer/carrier-directed (the employer selects the treating physician in Indiana); chiropractors must bill within 120 days (631 IAC 1-1-32), reimbursement follows the pecuniary-liability/80th-percentile framework, and disputes run through the Worker’s Compensation Board billing-review process.
• MVA — since Indiana has no PIP, chiropractic MVA care is paid by optional MedPay (up to limits), the patient’s health plan, or on a third-party lien / letter-of-protection basis at settlement, with the 2-year personal-injury SOL (IC 34-11-2-4) bounding the underlying claim. Not legal advice — verify benefits and current rules per payer.

Largely contract/payer-set, NOT fixed by an Indiana statute. The common initial-claim filing window for commercial/private payers in Indiana runs roughly 90-180 days from the date of service (many Anthem Blue Cross and Blue Shield of Indiana / Elevance, UnitedHealthcare, Aetna and Cigna commercial plans use ~90, 120, or 180 days; some allow up to 365 days — confirm the exact number in your participating-provider agreement or the payer’s provider manual, since it varies by plan and product).

Indiana context: the state’s prompt-pay law — IC 27-8-5.7 (Accident and Sickness Insurance; Provider Payment) — governs how fast the INSURER must adjudicate a CLEAN claim: an insurer shall pay or deny each clean claim within thirty (30) days if filed electronically or forty-five (45) days if filed on paper, with interest accruing thereafter (beginning the 31st day electronic / 46th day paper) per IC 27-8-5.7-6; it does NOT set the provider’s SUBMISSION deadline, which remains contractual.

Note: a fully-insured commercial plan governed by Indiana law differs from a self-funded ERISA plan (where federal law and the plan document control, and self-funded business is the majority of Elevance’s Indiana book) — verify which applies.

Federal limit: generally 12 months (one calendar year) from the date of service to submit an initial Medicare fee-for-service (Part B) claim. This is set by the Social Security Act (Sec. 1842(b)(3)(B)) and CMS in the Medicare Claims Processing Manual (Ch. 1), not by Indiana.

Medicare Advantage plans set their own contractual filing deadlines (often up to ~12 months, sometimes shorter) — confirm per plan. (For chiropractic specifically, Medicare covers only manual manipulation of the spine to correct a subluxation, 98940-98942, and requires the AT modifier for active/corrective treatment — see payerNuance.)

Indiana Medicaid (Indiana Health Coverage Programs / IHCP) is a 180-DAY state: initial fee-for-service provider claims for services rendered must be ORIGINALLY FILED within one hundred eighty (180) days of the date of service (or date of discharge for inpatient), per 405 IAC 1-1-3 (this 180-day window took effect for dates of service on or after January 1, 2019; before that it was 12 months).

The limit may be EXTENDED in defined circumstances under 405 IAC 1-1-3 — e.g., retroactive member eligibility (180 days from the date eligibility was established), office error/action delaying payment, reasonable continuous attempts to resolve a claim problem or to first bill a third-party-liability source, and Medicare/Medicaid crossover failures.

The IHCP managed-care entities (the MCEs/MCOs — Anthem, MHS/Managed Health Services, MDwise, CareSource, UnitedHealthcare Community Plan, administering Hoosier Healthwise, HIP, and Hoosier Care Connect) generally mirror the 180-day initial-filing window but set their own claim, correction, and appeal timeframes — confirm each plan’s exact rule.

Medicaid is the payer of last resort.

Indiana Workers’ Comp: medical PROVIDERS shall submit bills for services rendered within ONE HUNDRED TWENTY (120) DAYS of the date of service, per 631 IAC 1-1-32 (Medical provider fee claims), administered by the Worker’s Compensation Board of Indiana.

IMPORTANT carve-out: the Board has taken the position (in its Guidelines re. pecuniary liability) that DENYING a provider fee application or REFUSING to pay a bill for authorized care SOLELY because of the 120-day rule (631 IAC 1-1-32(2)(A)(i)) is IMPROPER — so the 120 days is a compliance requirement, not an automatic hard bar to payment of an otherwise valid, authorized bill (do not rely on this as a safety net; submit timely).

On the payer side, unless properly contested, bills are due and payable within ninety (90) days after the payer receives the bill (IC 22-3-3-5 / 631 IAC 1-1-32), and a contested bill requires the payer to send written notification of contest within ninety (90) days.

Reimbursement follows Indiana’s WC pecuniary-liability (80th-percentile) framework, and billing-review/dispute procedures run through the Board. Confirm each carrier/TPA’s specifics.

Indiana is a FAULT/tort state — it is NOT a no-fault/PIP state, and PIP is not sold here; first-party auto medical coverage is OPTIONAL Medical Payments (MedPay), which pays your own medical bills regardless of fault up to the policy limit.

There is therefore NO short statutory ‘days-from-service’ bill-submission deadline like a true PIP state has; submission timing is governed by the auto policy’s own terms (notify and submit proof of claim promptly per the policy).

Practical norms: bill MedPay and/or the patient’s health insurance promptly; for the third-party (at-fault driver’s) liability claim, the underlying bodily-injury tort claim is bound by Indiana’s TWO-YEAR personal-injury statute of limitations (IC 34-11-2-4), so all care and billing must be assembled well within that window.

Many MVA chiropractic claims in Indiana are ultimately handled on a letter-of-protection / lien-at-settlement basis when MedPay is exhausted or absent. Confirm each policy’s notice/proof-of-claim terms.